Healthcare fraud, waste, and abuse is estimated to exceed $200 billion per year. Rogue healthcare service providers (physicians, ambulance services, homecare providers, etc.) perpetrate most of the fraud, waste, and abuse, which negatively impacts the affordability of healthcare throughout the healthcare system. Fraud similarly affects several industries. Previous efforts to prevent fraud, waste, and abuse focused on examining individual claims, which is resource intensive and often requires the fraud, waste, and abuse to be extreme for it to be detected.
It is with respect to these and other considerations that examples will be made.